In many ways, the specialty of cardiology is ahead of the curve because it has been focused on initiatives aimed at cutting costs while improving the quality of care, Kathleen Blake, MD, a cardiac electrophysiologist with extensive experience in health policy, told MedPage Today.

"We will have to continue down that road, continue to utilize registries and performance measures as a means of providing the best possible care as millions of more patients enter into the healthcare system," said Blake, who is now senior research director at the Center for Medical Technology Policy in Baltimore.

But it might also be helpful if those in cardiovascular medicine took a page from primary care. "The primary care arena has done a good job of beginning to build teams with nurses, nutritionists, pharmacists, and others to better accommodate the heavier workload," Blake said. "Cardiologists also will need to learn how they can take good care of patients as part of a team."

With the influx of millions of newly insured patients into the healthcare system, the delivery of cardiovascular care will have to streamlined, Blake said. The use of electronic health records (EHRs) should help with the multidisciplinary team-based care model by reducing duplicative tests and ensuring quicker diagnoses.

EHRs also make it easier to mine data so that practices can compare their performance with national standards.

Preventive care is a big part of the new health law and it's likely that cardiologists will be at the forefront of prevention efforts, Blake said. In fact, the American Heart Association (AHA) last year established the 2020 Health Impact Goal and was a partner in the public- private initiative known as Million Hearts. The former seeks to reduce deaths caused by heart attack and strokes, while the latter aims to reduce the rate of heart attack and stroke.

Both initiatives call for cardiologists to increase primary and secondary prevention care, particularly through lifestyle counseling and a focus on hypertension, cholesterol, and smoking cessation.

"With better preventive care, people are more likely to get care in the right place, from the right people, at the right time," Blake said.

But cardiologists are not immune to partisan politics and the specialty had its share of docs who did not support the ACA. Blake said that many cardiologists were "legitimately worried about the health of the Medicaid system."

There was a provision in the ACA, struck down by the Supreme Court, that would have allowed the secretary of the Department of Health and Human Services (HHS) to penalize states for not expanding their Medicaid program.

"There is a sense of some relief that the court made the decision that HHS could not take away all Medicaid funding if states didn't comply with Medicaid expansion," Blake said. "People are already dealing with Medicaid cutbacks and they were rightly concerned this would be a tipping point for their state budget."

Another area of the ACA that Blake said concerned her cardiology colleagues was the creation of the Independent Payment Advisory Board, or IPAB, whose structure is defined in the health law.

The 15-member advisory board -- appointees that would need confirmation -- are charged with making binding recommendations on how to reduce Medicare spending. If Congress doesn't agree with the IPAB budget, it must come up with a better plan that meets the same financial requirement or the IPAB budget would become law.

"The fact that these non-elected individuals would have that much power bothered a lot of people," Blake said. "They felt there should be more accountability than the current structure allows."

From 2015 until 2020, IPAB will concentrate on physician expenditures. After 2020, the board will include expenditures to hospitals and other healthcare entities.

"We've all seen how Congress sometimes can't agree on anything. Some people saw that as a sign that Congress would not be able to agree on an alternative budget, which would make IPAB's budget the law of the land. That concerned many people," she said.

Blake said she supports the ACA, and is glad that people who really need it will finally have access to care.

She practiced as an electrophysiologist for 25 years in New Mexico, a state that has one of the highest rates of uninsured individuals in the country. "It wasn't uncommon for some patients to wait until they turn 65 and receive Medicare to finally get the treatment they needed, including open heart surgery," she said. "I think the ACA will be better for us; it's not perfect, but it's better."

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